非控制性出血性休克低压复苏治疗效果的研究

Effects of hypotensive resuscitation on uncontrolled hemorrhagic shock in rats

目的 应用大鼠脾损伤非控制性出血性休克模型探讨低压及低压扩容复苏治疗非控制性出血性休克的可行性。方法 雄性Wistar大鼠 5 0只 ,在大鼠脾损伤模型复制成功后随机等分为 5组 ,组 1 :假手术组 ;组 2 :休克未处理组 ;组 3:常压复苏组 (急救期控制MAP在 80mmHg以上 ) ;组 4 :低压复苏组 (急救期控制MAP在 6 0mmHg±5mmHg) ;组 5 :低压扩容复苏组 (急救期输入硝普钠 5 μg·kg- 1 ·min- 1 ,同时输液控制MAP在 6 0mmHg± 5mmHg)。结果 1～ 5组平均存活时间 (min)分别为 1 80、73.5 0± 8.0 4、1 1 4 .30± 31 .33、1 4 6 .70± 2 8.0 7和 1 71 .6 0± 1 5 .74 ,除组1、组 5外 (P =0 .0 6 71 ) ,其余各组间比较均有统计学意义 (P <0 .0 5 ) ;2～ 5组的急救期出血量 (ml·kg- 1 )分别为 :3.79± 1 .39、1 7.4 1± 8.88、8.6 7± 4 .5 9、1 0 .33± 4 .31 ,其中组 3出血量明显高于其他各组 (P <0 .0 1 ) ;组 4、组 5与组 2比较出血量明显增多 (P <0 .0 5 )。结论 在非控制性出血性休克治疗中 ,低压及低压复合适量硝普钠扩容复苏方法可改善组织代谢 ,提高生存时间 。

Objective To study the effects of hypotensive resuscitation and larger volume fluid resuscitation on uncontrolled hemorrhagic shock and survival in rats with a standardized massive splenic injury model (MSI).Methods Following establishment of MSI model,fifty Wistar rats were randomly and equally divided into five groups, group 1: sham operated group, group 2: shock untreated group, group 3: normal MAP resuscitation group (during acute resuscitation phase MAP was kept at 80mmHg),group 4: hypotensive resuscitation group(during acute resuscitation phase MAP was kept at 60mmHg±5mmHg), group 5: larger volume fluid resuscitation with hypotensive resuscitation group(during acute resuscitation phase MAP was kept at 60mmHg±5mmHg, simultaneously infused SNP at 5μg·kg -1 ·min -1 ).Results The mean survival time in group 1～5 was 180, 73.50±8.04, 114.30±31.33, 146.70±28.07 and 171.60±15.74(min), respectively. Statistic significances were seen in each group ( P <0.05),except between group 1 and group 5 ( P =0.0671).The amount of bleeding in group 2～5 (during acute resuscitation phase ) was 3.79±1.39,17.41±8.88,8.67±4.59 and 10.33±4.31(ml·kg -1 ) respectively. The loss of blood in group 3 was significantly more than other groups ( P <0.05). Group 4 and group 5 enhanced the blood loss significantly compared with group 2 ( P <0.05).Conclusion Hypotensive resuscitation and adding SNP at a proper dose additionally could improve tissue metabolism and prolong survival time during hypotensive resuscitation from uncontrolled hemorrhagic shock. It is a more ideal resuscitation method compared with normal blood pressure resuscitation.